Zhu Jane M, Huntington Aine, Haeder Simon, Wolk Courtney, McConnell K John
Division of General Internal Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR 97239, USA.
Health Aff Sch. 2024 Sep 9;2(9):qxae110. doi: 10.1093/haschl/qxae110. eCollection 2024 Sep.
Cost and insurance coverage remain important barriers to mental health care, including psychotherapy and mental health counseling services ("psychotherapy"). While data are scant, psychotherapy services are often delivered in private practice settings, where providers frequently do not take insurance and instead rely on direct pay. In this cross-sectional analysis, we use a large national online directory of 175 083 psychotherapy providers to describe characteristics of private practice psychotherapy providers who accept and do not accept insurance, and assess self-reported private pay rates. Overall, about one-third of private practice psychotherapists did not accept insurance, with insurance acceptance varying substantially across states. We also found significant session rate differentials, with Medicaid rates being on average 40% lower than reported cash pay rates, which averaged $143.26 a session. Taken together, low insurance acceptance across a broad swath of mental health provider types means that access to care is disproportionately reliant on patients' ability to afford out-of-pocket payments-even when covered by insurance. While our findings are descriptive and may not be representative of all US psychotherapists, they add to scant existing knowledge about the cash pay market for an important mental health service that has experienced increased use and demand over time.
成本和保险覆盖范围仍然是获得心理保健服务的重要障碍，包括心理治疗和心理健康咨询服务（“心理治疗”）。虽然相关数据较少，但心理治疗服务通常在私人诊所提供，这些诊所的提供者往往不接受保险支付，而是依赖直接付费。在这项横断面分析中，我们使用一个包含175,083名心理治疗提供者的大型全国在线名录，来描述接受和不接受保险的私人执业心理治疗提供者的特征，并评估自我报告的私人付费率。总体而言，约三分之一的私人执业心理治疗师不接受保险，保险接受情况在各州之间存在很大差异。我们还发现了显著的诊疗费用差异，医疗补助计划的费用平均比报告的现金支付费用低40%，现金支付费用平均每次诊疗为143.26美元。综合来看，广泛的心理健康提供者类型中保险接受率较低意味着，即使有保险覆盖，获得护理的机会在很大程度上仍依赖于患者自掏腰包支付费用的能力。虽然我们的研究结果只是描述性的，可能并不代表所有美国心理治疗师的情况，但它们为现有的关于一项重要心理健康服务现金支付市场的稀缺知识增添了内容，随着时间的推移，这项服务的使用和需求都有所增加。
